A 73‐year‐old man underwent a right total right knee replacement for osteoarthritis. He had a background of ischaemic heart disease with previous coronary artery bypass grafting, diabetes mellitus and gout. His medications before surgery were aspirin, metformin, frusemide, atorvastatin, paracetamol, sotalol, ramipril and allopurinol. Sixteen minutes after spinal anaesthesia comprising bupivacaine, fentanyl and morphine in addition to intravenous (IV) midazolam, cefazolin and tranexamic acid, he developed anaphylaxis characterised by hypotension (systolic blood pressure, 60 mmHg), and generalised pruritus requiring IV metaraminol and adrenaline. His condition stabilised to allow completion of the procedure.
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- 1. Sharp G, Green S, Rose M. Chlorhexidine‐induced anaphylaxis in surgical patients: a review of the literature. ANZ J Surg 2016; 86: 237–243.
- 2. Rose MA, Garcez T, Savic S, et al. Chlorhexidine allergy in the perioperative setting: a narrative review. Br J Anaesth 2019; 123: e95–e103.
- 3. Cai T, Verze P, Brugnolli A, et al. Adherence to European Association of Urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship. Eur Urol 2016; 69: 276–283.
- 4. US Centers for Disease Control and Prevention. Guideline for prevention of catheter‐associated urinary tract infections. Atlanta, GA: CDC, 2009.
- 5. Therapeutic Goods Administration. Australian Adverse Drug Reactions Bulletin, Volume 28, Number 2, April 2009. https://www.tga.gov.au/publication-issue/australian-adverse-drug-reactions-bulletin-vol-28-no-2 (viewed Dec 2020).
- 6. Parliamentary Standing Committee on Health, Aged Care and Sport. Walking the allergy tightrope: addressing the rise of allergies and anaphylaxis in Australia. Canberra: Commonwealth of Australia, 2020. https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/Allergiesandanaphylaxis/Report (viewed Dec 2020).
- 7. Australian and New Zealand College of Anaesthetists. Guideline on the perioperative management of patients with suspected or proven hypersensitvity to chlorhexidine. Melbourne: ANZCA, 2016. https://www.anzca.edu.au/getattachment/b4bca56d-0cab-4fbb-9617-46297c066abe/PS60-Guideline-on-the-perioperative-management-of-patients-with-suspected-or-proven-hypersensitivity-to-chlorhexidine (viewed Dec 2020).
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